Winds of Change Blowing at NCBTMB

By Rebecca J. Razo

In February, Massage Today reported on the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) election process in which board member Elizabeth McIntyre alleged unfair election practices after she was initially denied a place on the ballot to run for a second term ("Board Member Questions NCBTMB Election Process," www.massagetoday.com/archives/2005/02/01.html).

As a result, the NCBTMB immediately adjusted its election procedures, which included appointing a new Nomination Committee (NC), implementing revised election criteria, and subsequently reopening the application process to professional certificants and public members desiring a place on the ballot.

Around the time of McIntyre's complaint, Mark A.

Smith, PhD, CAE, who became the NCBTMB executive director in July 2004, announced he was leaving to take a position with the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

And more resignations followed when, in early February, NCBTMB Chair Judy Dean and Chair-Elect Neal Barry resigned from their positions on the board, citing personal reasons. Board members Garnet Adair and Elizabeth McIntyre were subsequently seated as chair and chair-elect, respectively.

Massage Today interviewed current NCBTMB Chair Garnet Adair and former NCBTMB Chair Judy Dean about the election process, the changes affecting the organization, and their respective outlooks on NCBTMB's future.

Editor's note: These interviews were conducted separately; neither Garnet Adair nor Judy Dean was made privy to the other's responses.

Interview with Garnet Adair, NCBTMB Chair

Massage Today (MT): Elizabeth McIntyre issued an open letter to the massage profession questioning the now former election practices at the NCBTMB. Some former board members expressed disapproval at the way she handled herself. How do you feel about the situation and how it was handled?

Garnet Adair (GA): I am not familiar with any former directors voicing disapproval that I'm aware of, so I can't speak to that. From my recollection, Elizabeth brought forth some questions last summer and they were never addressed and placed on the table for discussion by the chair at that time. There was a request for conversation that didn't take place and questions that were brought forward at a board meeting; she was told to take it to the Supervisor of Elections, which, according to our bylaws, if there's a question about the process, you take it to the Supervisor of Elections. The Supervisor of Elections did not return any contact, and the board was told at that time not to speak [about it]. I really feel that when there's been an opportunity, when there's been a request for many months for conversation and it is not addressed, then there would be some concerns that there were flaws.

GA: Absolutely. It's something she had tried to bring forward for a number of months.

MT: And what was she trying to bring forward? What were her concerns?

GA: I can't speak for her on this. From what I'm aware of, we [the board] needed to have a discussion about the election criteria needed for both the public member and practitioner directors in the election process, so that as people are doing interviews they can take the criteria into consideration to fit the picture that the board identified.

MT: Was there any conclusive evidence to support McIntyre's allegations of unfair election practices?

GA: To say that there was conclusive evidence means that there was a formal investigation; we did not have a formal investigation. But the directors took the information in and with the guidance of legal counsel, identified that there were enough concerns that should be addressed - there were concerns with perception.

MT: To your knowledge, were there flaws in Elizabeth's application that would have kept her off the ballot?

GA: I didn't see her application, so I don't know what was in there. But if somebody is told that they don't meet the criteria, they should be told what the criteria are. She inquired for that information from the Supervisor of Elections and never did hear back. The Supervisor of Elections resigned shortly after.

MT: Is McIntyre fit to continue for another term on the board?

GA: The certificant population identified her as fit to be on the ballot the first time, and she was a director that was in good standing. I don't know the criteria the [Nominating Committee] was looking at. Based solely on the fact that the certificant population had identified her as desirous to be on the board three years ago, it would have to be very clear to me what skills were not being met.

MT: McIntyre is now chair-elect.

GA: That is correct, which also tells me that she has strong support; it speaks clearly that the directors feel that she's not only qualified to remain as a director but also qualified enough to [eventually] serve as chair.

MT: Do you think it's coincidental that Judy Dean and Neal Barry resigned from their positions as chair and chair-elect following the events of Elizabeth McIntyre and the election process? Do you believe the resignations were related? Is there a "real" story behind this?

GA: If there's any story behind that, if there's any connection, I'm really not aware of it. Neither of them has brought that information forward and discussed it with any of the directors in a director forum. If they've discussed it individually, I'm not aware of it.

MT: That's two resignations at the same time; it seems there was a little bit of turbulence at the time this was going on, so I'm wondering if that concerns you at all for the future of the board?

GA: It is certainly not the most desirous for any board to lose their chair and chair-elect at the same time. They both, within their letters to the board, indicated personal reasons, but it was not based on dissatisfaction about what was going on or personal dissatisfaction with their roles.

MT: At this point in time, has the election process been improved or changed?

GA: We're working to have our newly elected directors seated no later than June 30, instead of the beginning of May as the bylaws show. We're making some changes this year that will cease after this election, specifically to allow us to have the directors in place a little bit later than what we normally have. We are working on having the criteria so that people doing the interviews will have the criteria that were missing in the last election.

MT: What are the core requirements to run for the board?

GA: According to the bylaws, you need to be a practitioner that's been out of school for at least three years; you need to be a certificant, and a certificant in good standing. We also have some other criteria that there cannot be any more than X number of people involved in a school, X number of people involved in a regulatory arena, X number of people on a competing board of directors or organization. We have to know that people fit into those, but we don't have any more than what the bylaws allow for in those categories.

The Leadership Development Committee years back created some additional criteria that was tweaked each year so that they would know what the needs of the board were, but it was never ready so the candidates didn't know [the qualifications]. I could use Elizabeth as an example. She's been a practitioner for at least three years, she's a certificant and she's a certificant in good standing. Other than that, she wouldn't know when submitting the paperwork if there were particular skills that were needed. That's why we need to have public information.

Another thing that was very uncomfortable was that no one knew who the [Nominating] Committee members were. It was asked. In fact, I asked a couple of times. That information was never given to any of the directors; we did not find out who the committee members were until January. It's really uncomfortable when you have a transparent election process but you don't know who is on the NC, and it's never been something that is secretive. Everybody has always known who has been on the NC.

MT: Who knew the members of the NC?

GA: The chair of the board had to approve everyone.

MT: Was there any reason given why the names were kept confidential?

GA: All we were told was "I don't have that list in front of me"; "I don't know" was the answer when we asked.

MT: There is going to be a new exam and new eligibility requirements coming soon.

GA: Eligibility criteria will change effective June 1 for the National Certification Examination for Therapeutic Massage and Bodywork, and we are coming out with the National Certification Examination for Therapeutic Massage, which is for massage only.

MT: In developing the new eligibility requirements, NCBTMB surveyed 500 nationally certified massage therapists. If there are 100,000 massage therapists nationally, this number represents only 0.5 percent of the massage therapy population. Isn't it a little presumptuous for the NCBTMB to assume that these 500 therapists speak for the entire profession in coming up with these new eligibility requirements?

GA: We don't currently have 100,000 certificants. We have somewhere around 85,000, and when the job task analysis was done about a year and a half ago, it was significantly less than 85,000.

MT: Right. But in the massage profession as a whole, obviously not everyone is certified. That would put the number at about 100,000 massage therapists - if not more - in the United States. If only 500 therapists were polled for the entire profession, isn't that a small sample of therapists to create widespread eligibility requirements for the entire profession?

GA: I would have to defer that question to the person that was the Director of Certification at that time. I don't know, in my familiarity with the job task analysis and our ability to be accredited under the National Commission for Certifying Agencies (NCCA), if there is any specific criteria or what percentage is to be included in the job task analysis. I would not be able to say if it was presumptuous or not. If there were specific criteria that we were to follow within our accreditation, then I know that it was followed.

MT: How about in your professional opinion, was it fair to interview 500 massage therapists out of - we'll say on the low end - 80,000 nationwide then create exam eligibility requirements based on that small percentage?

GA: As the chair of the board, I can't really state my own professional opinion. I have to respond as the spokesperson for the organization and in that case, again, I would defer that question to the Director of Certification for you to know for sure that we followed the criteria that we are obligated to abide by.

MT: I'm not questioning whether the criteria were followed. I'm questioning the number of therapists that were surveyed, and based on that limited number of surveys, the creation of new eligibility requirements. I'm not questioning the validity of how the process was done. I'm questioning more why the sampling wasn't wider than 0.5 percent of the massage therapist population...would you still defer me to the Director of Certification?

GA: Yes, I would.

MT: Are you satisfied, then, that the new eligibility requirements implemented on June 1 are appropriate and fitting to the process of certification?

GA: Yes. The board had a conversation about that recently, and we confirmed that there is a sound reason behind how those numbers came forward.

MT: Will the NCBTMB be hiring a new executive director from outside the management company it has had under contract since 1992? Is the NCBTMB becoming a stand-alone company with employees of its own?

GA: Yes, we are. In fact, you're the first person that gets to officially hear this. The decision was made awhile back, but we did not place it in our minutes until recently. We have not done a press release, but it is public information. There will be an official press release forthcoming.

MT: Why was this decision made?

GA: I think there is always a growth time where organizations find that they are ready to move out on their own. This is something that has been spoken about for numerous years. Natural growth would take us at some point to a stand-alone organization, and that time is now.

MT: Can you describe the transition plan for becoming a stand-alone company that will ensure the interests of massage therapists, schools and state regulatory agencies?

GA: I won't be able to describe the specific transition. But what I do want to communicate is that it is going to be done so that it is as seamless a transition as possible. It is very important for the directors to have our stakeholders feel the least amount of glitches. Sometimes, there are extenuating circumstances; things come up and there could be some adjustments. But we're trying to make it as seamless as possible.

MT: Will the NCBTMB be moving its headquarters location?

GA: That we don't know. We have to take in a lot of things in making the decision of what is going to be best for this organization. We're not even close to making a decision at this point.

MT: Some massage therapists believe that the NCBTMB and the AMTA are working together to "monopolize" the massage therapy profession. Can you describe the NCBTMB's relationship to the AMTA?

GA: I can see that because AMTA was the springboard of national certification there is an [impression] we are still associated. They are another professional related organization. One is a membership organization; one is a voluntary certification. Many membership organizations have an arm of certification under their same umbrella. [NCBTMB] is a separate entity from the membership organization. There could be some confusion based on some familiarity of other membership organizations having a certifying arm.

MT: If there was another certification examination for massage therapists, would you be opposed to it or supportive?

GA: Because this is a growing industry, it is certainly not something that is not ever going to happen. Would I be supportive of it? If McDonald's was next door to Burger King I don't know that one would be necessarily supportive of the other, but there are going to be personal preferences - a person might elect to go to one place compared to the other. With that, I think that competition is not a bad thing. In fact, many times it can be a very good thing. So, I can't say that we would be supportive of it, but I can't say that we would campaign against or try to stop any organization from providing another certifying exam.

MT: The exam itself seems sometimes to be a source of frustration for therapists. Many therapists have complained that several questions have little or nothing to do with bodywork. Others have indicated they believe the test is biased. I'll give you an example. One of our readers wrote to us and said the following:

"Some of its current questions are inaccurate; others confusing; some amazingly simple; a few incomprehensively difficult; and a few questions promote modalities. One of the questions I had to answer when I took the test:

There is no right answer to the above question; it was chosen to promote a stretching modality."

What, if anything, is the NCBTMB doing to address these types of complaints?

GA: The exam questions are created by people called in specifically to write questions - subject matter experts. The questions are researched and referenced so that each one has at least two - and it might be three - references to books or other articles that support the answer, then those questions become beta tested.

Where we have 160 questions on the exam, 150 of them are actually graded. The remaining 10 questions are beta tested for clarity, consistency, and to be sure that they are clearly understood by the population taking them to determine whether there needs to be some additional tweaking or clarification before they become test questions that are actually graded. I know the questions go through quite a process before they are included in an exam.

When I took my exam, I remember thinking on some questions, "I've never heard of this before," but I could usually rule out a couple of the answers and then use my critical thinking in making the determination based on the education I have as to the most logical answer to that question.

MT: Do you think there is room to improve some of the questions on the exam as it stands right now?

GA: Everything can always stand for improvement. To say that there is no room for improvement would be incorrect; if I said there is room for improvement, I don't want it to be thought that we feel our test is faulty in any way. I think that it is very representative of - to tie into the job task analysis - the information that we have gathered from that survey.

MT: So, are you satisfied with the test as it stands?

GA: Yes, I am.

MT: I have spoken to readers who have expressed dissatisfaction with how the NCBTMB serves the profession. We've heard that the NCBTMB is notorious for poor customer service, that calls are often not responded to, that paperwork is lost over and over again, etc. Do any recent and/or pending changes specifically address this perceived shortcoming or does the NCBTMB have any plans for improving its customer service policies?

GA: Yes. Customer service is something we are adamant about getting a much better public image out there. We have recently added more staff. The goal is to cut our turnaround time to three weeks. Currently, it is right at four weeks but that was before we brought in additional staff, so that number should be coming back down to three soon.

MT: Where do you see the NCBTMB in five years?

GA: I anticipate that we are going to stay on the cutting edge of certification, still keeping our ear to listening to our stakeholder groups because they are very important to us, and we want them to know that we have two-way communication, so that we can keep those relationships strong and those alliances healthy.

The National Certification Board is very strong; we are a unified group and are excited about the direction the organization is going in as a stand-alone, as well as our changes in the exams that are coming forward. We have a lot on our plate, but it is not overwhelming or too daunting for this board to address.

Interview with Judy Dean, Former NCBTMB Chair

Massage Today (MT): Elizabeth McIntyre issued an open letter to the massage profession questioning the now former election practices at the NCBTMB. How do you feel about how the situation was handled?

Judy Dean (JD): Ms. McIntyre originally shared the letter of rejection from the NC during a board call in late December. At that time, fellow board members voiced their concerns and surprise regarding the committee's decision. As chair, I informed the board that further clarification was to occur between the NC chair and Ms. McIntyre, and that individual board members were not to become involved in the process, as it could be interpreted as board interference or strong-arming the nomination process. I was unaware of Ms. McIntyre's further communication to the massage community until I received a copy of [her] letter from a fellow board member.

Components of Ms. McIntyre's letter did reflect a form of campaigning, which is not permitted in the election process, as well as allegations that my appointment of the NC chair possibly influenced the committee's decision. Once a chair of the NC is made, board members are expected to step away from the process so that there is no perception of influence or interference with the process. Ms. McIntyre's sharing of her perceived concerns outside "the walls" of the boardroom resulted in a snowball effect in that a member of the Ethics Committee took it upon herself to share the letter in a massage therapy chat room Web site, and from there, to additional media. This member also shared the private e-mail addresses of all the board members so that chat room members could contact us directly.

The response letters of support for Ms. McIntyre reflected a reaction to inaccurate information presented by Ms. McIntyre - namely, that not all the committee members were nationally board certified or massage therapists/bodyworkers. In fact, they were all nationally certified. In addition, the comment that the NC chair was a friend and colleague [of mine] was true, but if investigated further it would have become known that this individual was a fellow RN/board certified massage therapist and we had worked together seven years ago at a state university nursing school located in a large Midwestern city, a good distance from my location in Indiana. The NC chair was selected based on being an individual highly regarded within the nursing and massage therapy communities for her professional, ethical manner.

In hindsight, I should have delegated actions regarding the NC to Chair-Elect Neal Barry, but at the time I appointed the NC chair, I had no intent of submitting my name for consideration for the election slate. As NCBTMB board dynamics changed, so did my decision to submit my name for consideration. This decision occurred in mid-September, not in May when the committee was formulated.

MT: Did Elizabeth request information about the election process for several months prior to taking action? To your knowledge, what were her concerns related to the election process?

JD: Shortly after I became chair in May 2004, Ms. McIntyre shared concerns that election guidelines and criteria for the public member were not specific enough; she also asked fellow board members to identify those attributes needed by public members. At that time, Ms. McIntyre did not mention any concern regarding the criteria for slate selection for board members.

It is important to note that the previous Leadership Development Committee, of which the NC was a component, had ceased functioning at the May 2004 board meeting due to both co-chairs and members resigning because of their limited abilities to devote time and energy to the committee. In order to meet the deadlines for the election process, a Leadership Development Task force led by a newly elected board member, was initiated to assess the needs of the board and develop a process whereby a more comprehensive leadership development process could be put into place. This new approach to leadership development was not fully developed and presented until Jan. 2005 and, therefore, was not in place for use by the NC. The guidelines the NC used were those of the previous year, which had not created any concerns or problems. But Ms. McIntyre felt that the NC members were ill prepared, as they had no previous interaction and exposure to the board and could not fully assess and evaluate the needs of the board.

Maybe more attention should have been given to the initial concerns of the public member criteria, but at the time there were many more pressing issues impacting future NCBTMB directions; however, I take full responsibility for any shortcomings in this area.

MT: One of McIntyre's complaints was that the names of the NC members were kept confidential. What was the reason for this?

JD: Once the NC is in place, it is the directive that all board members are to distance themselves from any involvement so that any perceived or actual influence will not occur. I am not aware of who told Ms. McIntyre that the names were unavailable, which may have been due to protecting the committee members from being harassed or quizzed by potential candidates.

Ms. McIntyre did state that as a board member she had the right to know who was on the committee, but again, as a potential candidate, any contact by her with the committee members may have been seen as undue influence. Ms. McIntyre did state that when she heard that the individual she recommended for consideration as a public member was not selected, she contacted the chair of the NC and asked why this occurred.

MT: Was there any conclusive evidence to support McIntyre's allegations of unfair election practices?

JD: Any time activities of the board or its members become questionable, it is imperative for the board to respond and investigate. The nomination process was discussed at a board call; it was suggested that the board hear the NC's side of the story but the majority of the board rejected this option. In addition, there was a question posed wondering if Ms. McIntyre had been selected, would this situation still have occurred? There was no conclusive evidence that a conflict of interest was present regarding myself or the selection of the NC chair.

It was noted that committee members recused themselves from any discussion regarding individuals they knew. In a recent (early March) conversation with the former NC chair, she reiterated that the members took their responsibilities very seriously and were committed to submitting names of those individuals who would best serve the profession and bring additional talents to the board.

MT: To your knowledge, were there flaws in Elizabeth's application that would have kept her off the ballot?

JD: Ms. McIntyre's application process was no different than others that applied for consideration. Any flaws reflected either in the application or interviews are confidential within the NC. This information is never shared outside the parameters of the committee structure; I am unable to comment on any flaws, as I and other board members were never privy to that information.

MT: Do you believe McIntyre is fit to continue for another term on the board?

JD: Each board member brings positive attributes to the table that, when utilized to the fullest, can bring about positive forward movement to the organization. Unfortunately, less-than positive behaviors are also included. As chair, it was my responsibility to assess and utilize all those positive talents in achieving various goals. Ms. McIntyre was chosen to chair two task force activities based on her abilities to organize, assess and deliver the results in a timely manner.

Is she fit to continue for another term? That is a moot point. My departure from the board, as well as Mr. Barry's resignation, opened the door for Ms. McIntyre to become chair-elect, bypass the nomination process, bypass the election process via certificant votes, and be assured additional time on the board with the subsequent position to chair.

MT: You and Neal Barry resigned your positions as chair and chair-elect at the same time. An NCBTMB press release cited "personal reasons" for the departures. Did your resignations have to do with the events of Elizabeth McIntyre? Is there a "real" story behind the resignations?

JD: Any decision affecting my personal, family or professional life is seldom based on just one factor. The decision to resign from the board and my withdrawal from the election process primarily resulted from a long-term and increasing challenge of compromised mobility in my ambulation. I determined that an improved quality-of-life needed my full attention, and this took precedence over further volunteer activities.

I also assessed the amount of energy and time (16-20 hours per week) that I spent as chair over eight to nine months and determined that my energy would best be served if allocated to my needs, rather than a board whose dynamics had changed related to its direction, interpretation of its mission and blurring of the roles of board members; a board who was constantly responding with either a form of management by crisis or inertia of decisions; where communication styles often impeded progress of timely decisions; where the board was without the consistent support of an executive director; where a lack of trust for the duly elected board officers was stated by several board members; and where there was an inconsistent utilization of a knowledge-based, decision-making process.

These factors, in addition to my own personal health care needs and family responsibilities, formulated my decision to submit a full resignation rather than share my time and energy addressing the challenges faced by the board at that time. Mr. Barry's resignation occurred two days following mine. I am unable to respond as to his reasons.

MT: In developing the new exam eligibility requirements to be implemented on June 1, NCBTMB surveyed 500 nationally certified massage therapists. If there are 100,000 massage therapists nationally, this number represents only 0.5 percent of the massage therapy population. If only 500 therapists were polled for the entire profession, isn't that a small sample of therapists to create widespread eligibility requirements for the entire profession?

JD: I would agree that 500 surveyed massage therapists appear to be a small number. In discussing this with the former director of certification, it was explained that even if larger numbers had been used, the end result would have been the same - the only difference was in the number of responses.

For example, a question is asked of 500 people and 90 percent responded with the same interpretation; the same question is asked of 1,000 individuals and 90 percent of them responded with the same interpretation. It's the small number that gets your attention. Although thousands of surveys were mailed, only 500+ completed surveys were returned. That in itself says a lot.

It has been argued that only faculty should be surveyed since they teach what beginning practitioners need to know, but in essence, NCBTMB surveys those who are actually at the table, those practitioners who see clients on a regular basis; those who - as we used to say in nursing - are "in the trenches."

MT: Are you satisfied that the new eligibility requirements are appropriate and fitting to the process of certification?

JD: Massage therapists/bodyworkers provide services to consumers who present with myriad of pre-existing physical conditions. Today's consumer is usually well-educated in his/her desire for an adjunct to his/her current health care regimen or a stand-alone service. It is imperative that practitioners know the usual and customary contraindications, but the consumer also expects the therapist to have some knowledge of their particular challenge. Therefore, increased hours in A & P, pathology, and business ethics make for a better-prepared practitioner.

Others will argue that therapists employed in spas and those providing relaxation massages do not need additional educational preparation. Well, prove to me that all clients using spa services do not have physical/medical challenges. Regardless of where one practices, an educationally prepared graduate makes for increased credibility with consumers, regulators and members of other health care professions.

MT: Where do you hope to see the NCBTMB in the next five years?

JD: My thoughts go beyond a five-year plan. Given the expansion in the number of massage therapists/bodyworkers, the following would be my desire:

The development of a national core curriculum to reflect the expansion of both the scope-of-practice and diversity of services provided. This means an increase in the number of education hours or the development of an across-the-board competency based education. The basic educational program would provide a solid infrastructure on which the practitioner would build advanced education to specialize in whatever area desired;

The movement of educational programs into an associate's degree/undergraduate degree format, possibly through alignment with current privately owned programs, and the movement away from corporate-owned schools;

All states would have licensure and practice acts reflecting the profession;

Each state would have its own separate board of massage;

The development of a consortium of all state massage boards, which would develop a national exam to be used by all states as a measure of minimal safe competent practice;

The eventual removal of the tie between national certification and licensure to practice at the state level;

A return to the voluntary approach to national board certification, as seen in other health care professions;

Board certification for faculty members, administrators and researchers. Their areas of expertise are not tableside and should not be evaluated using the same criteria as hands-on practitioners;

That NCBTMB actively pursue a collaborative dialogue with Canada, Europe and South America in developing an international certification program.

MT: And what are your plans for the future and your career?

JD: My personal plans are to spend more time with family and friends, and develop strategies to reopen and expand my private massage therapy and hypnosis practice. Professionally, I will revisit career goals I established seven years ago when I left the academic world of nursing education. I may again return to areas of my expertise - health care, continuing education consulting, or the speakers' circuit for presentations on the integration of CAM and nursing. Or, I may just enjoy the role of student again...so many options, so little time.

MT: Any other comments?

JD: As I stated in my resignation letter to the board, I wish them well in their individual and collective efforts as they implement positive strategies that will affect the future of the NCBTMB.

To contact the NCBTMB with questions, comments, or suggestions for improvement, readers are asked to direct communication to the attention of the "chair of the board."

Look for updates on other issues affecting the NCBTMB in future editions of Massage Today.

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